Kaeo after-hours GP service closes

People will now have to drive 55km to get after hours healthcare and pay $35 now Kaeo's after-hours GP service has shut down.

Whangaroa residents have to drive an extra 110km and spend significantly more to see a doctor outside working hours after Kaeo's after-hours GP service was shut down.

Patients of the Whangaroa Health Services Trust (WHST) are among the few in Northland to enjoy free GP visits. Until February that included free after-hours visits at the former Kaeo Hospital.

Now, however, Whangaroa patients who want to see a GP after hours, but are not sick enough to need an ambulance, have to drive 55km each way to Bay of Islands Hospital in Kawakawa and pay a $35 fee.

WHST chairman Brendan Tuohy said he did not want to pick a fight with the Northland District Health Board (NDHB), the trust's funder, over the closure.

However, in a report in the local newsletter Whangaroa Whispers, he accused the trust's interim chief executive of following a covert NDHB agenda of closing the after-hours service despite a trust policy to keep it open. That is denied by the NDHB and the chief executive has since departed.

Mr Tuohy said Whangaroa residents now had to drive an extra 45 minutes each way to Kawakawa after hours and pay $35 for what used to be a free consultation. Using the standard reimbursement rate of $0.77/km, driving to Kawakawa and back costs about $84. The changes had the greatest impact on Whangaroa's poorest residents and discouraged them from accessing health services.

The abrupt end to the service meant the trust had no chance to consult or prepare its patients, he said.

However, Mr Tuohy's report also explained the pressures on the after-hours service.

That included a roster that was tough on WHST's GPs because it required them to be on call at least one night in four, leaving them tired and at risk of burning out.

Rural after-hours GP services had also fallen out of favour for clinical safety reasons. In an emergency, patients were better off calling an ambulance or going straight to hospital. That was especially true in Kaeo because most of the on-call GPs lived in Kerikeri. By the time they got to Kaeo half an hour had been lost.

Rose Lightfoot, chief executive of Te Tai Tokerau Primary Health Organisation, said any decisions about after-hours services were ultimately up to GPs, not the health board.

Ms Lightfoot said Whangaroa's after-hours service was unsustainable because only three or four GPs were available to work the roster. Like many rural areas Whangaroa found it hard to attract doctors. It had also seen a significant turnover in recent years.

"The after-hours commitments undoubtedly make these roles less attractive. The population of 3000 people is too small to sustain its own after-hours service, and prior to its closure patients would have a doctor available in Whangaroa some days and needed to go to Kawakawa on the days when a doctor was unavailable. This caused a lack of clarity for the population and in itself could put patients at risk and delay them getting seen and treated," she said.

WHST still provided a superb GP service during the day, she said. Few other places in New Zealand, if any, had funding for three to four doctors for just 3000 people.

The NDHB first proposed closing the after-hours service in a 2013 review aiming to free up money for community health services but backtracked after a public outcry. That review also proposed closing Kaeo's GP beds and Kauri Lodge rest home.

Following the closure of the after-hours service Mr Tuohy said the WHST had hired a new chief executive and was continuing to develop its new "model of care".

Whangaroa and Hokianga residents get free GP visits due to a combination of historic factors and the areas' socio-economic deprivation.

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